Elimination Diet

An elimination diet is used to learn whether or Many people notice that in the first week, not certain foods may be causing your especially in the first few days, their symptoms symptoms or making worse. If they are, will become worse before they start to improve. the diet also can become way to treat these If your symptoms become severe or increase symptoms. for more than a day or two, consult your health care practitioner. There are four main steps to an elimination diet: Step 3 – Challenging • If your symptoms have not improved in two Step 1 – Planning weeks, stop the diet and talk with your health care practitioner about whether or not to try it Work with your health care practitioner to learn again with a different combination of foods. which foods might be causing problems. You may be asked to keep a diet journal for a week, • If your symptoms improve, start “challenging” listing the foods you eat and keeping track of your body with the eliminated foods, one the symptoms you have throughout the day. food group at a time. As you do this, keep a (See the last page of this handout for a chart written record of your symptoms. you can use). It is helpful to ask yourself a few To challenge your body, add a new food key questions: group every three days. It takes three days • What foods do I eat most often? to be sure that your symptoms have time to • What foods do I crave? come back if they are going to. On the day you try an eliminated food for the first time, • What foods do I eat to “feel better”? start with just a small amount in the morning. • What foods would I have trouble giving up? If you don’t notice any symptoms, eat two larger portions in the afternoon and evening. Often, these seem to be the foods that are most a day of eating the new food, remove it, important to try not to eat. See page 2 for a list of and wait for two days to see if you notice the the most common problem foods. symptoms. Step 2 – Avoiding If a food doesn’t cause symptoms during a For two weeks , follow the elimination diet challenge, it is unlikely to be a problem food without any exceptions. Don’t eat the foods and can be added back into your diet. whole or as ingredients in other foods. For However, don’t add the food back until you example, if you are avoiding all dairy products, have tested all the other foods on your list. you need to check labels for whey, casein, and lactose so you can avoid them as well. This step NOTE: If a food causes you to have an takes a lot of discipline. You must pay close immediate allergic reaction, such as throat attention to food labels. Be particularly careful if swelling, a severe rash, or other severe you are eating out, since you have less control allergy symptoms, seek medical care and over what goes into the food you eat. avoid food challenges unless you are directly supervised by a physician.

PATIENT HANDOUT University of Wisconsin Integrative Medicine www.fammed.wisc.edu/integrative Elimination Diet

Example of an Elimination Diet Calendar Modified elimination diet (dairy and gluten free)* Day Number Step The most common food proteins that can cause 1 Begin Elimination Diet intolerance are cow’s milk protein and gluten You may notice symptoms worse from wheat. A modified elimination diet removes 2-7 for a day or two dairy and gluten and any other specific foods Symptoms should go away if the that may be craved or eaten a lot. 8-14 right foods have been removed • Eliminate all dairy products, including milk, Re-introduce food #1 (for cream, cheese, cottage cheese, yogurt, 15 example, dairy) butter, ice cream, and frozen yogurt. Stop food #1 and watch for • 16-17 Eliminate gluten, avoiding any foods that symptoms* contain wheat, spelt, kamut, oats, rye, barley, Re-introduce food #2 (for 18 or malt. This is the most important part of the example, wheat) diet. Substitute with brown rice, millet, Stop food #2 again and watch for 19-20 buckwheat, quinoa, gluten-free flour symptoms products, or potatoes, tapioca and arrowroot 21 Re-introduce food #3 products. ….And so on Other foods to Eliminate *You only eat a new food for one day. Do not add it back into your meal plan again until the elimination • Eliminate fatty meats like beef, pork, or veal. diet is over. It is OK to eat the following unless you know that you are allergic or sensitive to them: Step 4 – Creating A New, Long-Term Diet chicken, turkey, lamb, and cold-water fish Based on your results, your health care such as salmon, mackerel, sardines and practitioner can help you plan a diet to prevent halibut. Choose organic/free-range sources your symptoms. Some things to keep in mind: where available. • This is not a perfect test. It can be confusing • Avoid alcohol and caffeine and all products to tell for certain if a specific food is the that may contain these ingredients (including cause. A lot of other factors (such as a sodas, cold preparations, herbal tinctures). stressful day at work) could interfere with the • Avoid foods containing yeast or foods that results. Try to keep things as constant as promote yeast overgrowth, including possible while you are on the diet. processed foods, refined sugars, cheeses, • Some people have problems with more than commercially prepared condiments, one food. peanuts, vinegar and alcoholic beverages. • Be sure that you are getting adequate • Avoid simple sugars such as candy, sweets nutrition during the elimination diet and as and processed foods. you change your diet for the long-term. For • Drink at least 2 quarts of water per day. example, if you give up dairy, you must supplement your calcium from other sources like green leafy vegetables. • You may need to try several different elimination diets before you identify the problem foods.

PATIENT HANDOUT 2 University of Wisconsin Integrative Medicine www.fammed.wisc.edu/integrative Elimination Diet

Food group Allowed Avoid meat, fish, poultry chicken, turkey, lamb, cold water red meat, processed meats, eggs fishes and egg substitutes dairy rice, soy and nut milks milk, cheese, ice cream, yogurt legumes all legumes (beans, lentils) none vegetables all creamed or processed fruits fresh or juiced strawberries and citrus starches potatoes, rice, buckwheat, millet, gluten and corn containing quinoa products (pastas, breads, chips) breads/cereals any made from rice, quinoa, all made from wheat, spelt, amaranth, buckwheat, teff, millet, soy kamut, rye, barley or potato flour, arrowroot soups , vegetable-based canned or creamed beverages fresh or unsweetened fruit/vegetable dairy, coffee/tea, alcohol, citrus juices, herbal teas, filtered/spring drinks, sodas water fats/oils cold/expeller pressed, unrefined light- margarine, shortening, butter, shielded canola, flax, olive refined and spreads oils, salad dressings, pumpkin, sesame, and walnut oils nuts/seeds almonds, cashews, pecans, flax, peanuts, pistachios, peanut pumpkin, sesame, sunflower seeds, butter and butters from allowed nuts sweeteners brown rice syrup, fruit sweeteners brown sugar, honey, fructose, molasses, corn syrup

NOTE: If you are using the elimination diet for Irritable Bowel Syndrome, consider eliminating the following foods for two weeks: dairy (lactose), wheat (gluten), high fructose corn syrup, sorbitol (chewing gum), eggs, nuts, shellfish, soybeans, beef, pork, lamb.

PATIENT HANDOUT 3 University of Wisconsin Integrative Medicine www.fammed.wisc.edu/integrative Elimination Diet

Some helpful tips A number of foods can be ‘disguised’ when you look at food labels.

If you are avoiding Also avoid Dairy Caramel candy, carob candies, casein and caseinates, custard, curds, lactalbumin, goats milk, milk chocolate, nougat, protein hydrolysate, semisweet chocolate, yogurt, pudding, whey. Also beware of brown sugar flavoring, butter flavoring, caramel flavoring, coconut cream flavoring, “natural flavoring,” Simplesse. Peanuts Egg rolls, “high-protein food,” hydrolyzed plant protein, hydrolyzed vegetable protein, marzipan, nougat, candy, cheesecake crusts, chili, chocolates, pet food, sauces. Egg Albumin, apovitellin, avidin, béarnaise sauce, eggnog, egg whites, flavoprotein, globulin, hollandaise sauce, imitation egg products, livetin, lysozyme, mayonnaise, meringe, ovalbuman, ovogycoprotin, ovomucin, ovomucoid, ovomuxoid, Simplesse. Soy Chee-fan, ketjap, metiauza, miso, natto, soy flour, soy protein concentrates, soy protein shakes, soy sauce, soybean hydrolysates, soby sprouts, sufu, tao-cho, tao-si, taotjo, tempeh, textured soy protein, textured vegetable protein, tofu, whey-soy drink. Also beware of hydrolyzed plant protein, hydrolyzed soy protein, hydrolyzed vegetable protein, natural flavoring, vegetable broth, vegetable gum, vegetable starch. Wheat Atta, bal ahar, bread flour, bulgar, cake flour, cereal extract, couscous, cracked wheat, durum flour, farina, gluten, graham flour, high-gluten flour, high-protein flour, kamut flour, laubina, leche alim, malted cereals, minchin, multi-grain products, puffed wheat, red wheat flakes, rolled wheat, semolina, shredded wheat, soft wheat flour, spelt, superamine, triticale, vital gluten, vitalia macaroni, wheat protein powder, wheat starch, wheat tempeh, white flour, whole-wheat berries. Also beware of gelatinized starch, hydrolyzed vegetable protein, modified food starch, starch, vegetable gum, vegetable starch. Modified from Mahan LK and Escot-Stump S, Krause’s Food Nutrition and Diet Therapy , 11 th ed. Philadelphia: Saunders. 2004.)

If you are allergic to latex, you may also react to: apple, apricot, avocado, banana, carrot, celery, cherry, chestnut, coconut, fig, fish, grape, hazelnut, kiwi, mango, melon, nectarine, papaya, passion fruit, peach, pear, pineapple, plum, potato, rye, shellfish, strawberry, tomato, wheat.

PATIENT HANDOUT 4 University of Wisconsin Integrative Medicine www.fammed.wisc.edu/integrative Elimination Diet

The information in this handout is for This handout was created by Adam Rindfleisch general education. It is not meant to be used MD, MPhil and David Rakel, MD, Integrative by a patient . Please work with your Medicine Program, Dept. of Family Medicine, health care practitioner to use the University of Wisconsin-Madison. information in the best way possible to promote your health . Date created: July 2008

NOTES

PATIENT HANDOUT 5 University of Wisconsin Integrative Medicine www.fammed.wisc.edu/integrative

SYMPTOMS EVENING FOODS EVENING SYMPTOMS AFTERNOON FOODS AFTERNOON SYMPTOMS MORNING FOODS MORNING (LOG IN FOODS (LOG IN EATEN ANDTIMES. NOTE THE SYMPTOMSY

DAY 1 DAY

A ONE WEEK FOOD DIARY CHART CHART DIARY FOOD WEEK ONE A DAY 2 2 DAY

DAY 3 3 DAY

DAY 4 4 DAY OU HAVE OU ANDTIMESWHAT ASWELL)

DAY 5 5 DAY

DAY 6 6 DAY

DAY 7 7 DAY